CAJ | 학술논문

目的分析小腿外侧腓动脉穿支皮瓣的特点,探讨腓动脉穿支皮瓣游离移植修复前足创面的临床应用. 方法回顾性分析小腿外侧腓动脉穿支皮瓣游离移植修复前足创面患者9例,皮肤缺损面积为4.5 cm×4.0cm～13.5 cm×6.5 cm;着重分析前足创面的特点以及小腿外侧腓动脉穿支皮瓣的设计、切取、血管吻合匹配等,术后随访皮瓣的成活、外观及踝足的功能恢复情况等. 结果 9例均在小腿外侧以腓骨小头与外踝连线中点稍上方附近找到发自腓动脉的较大肌皮穿支,且有明显的2条静脉伴行.移植皮瓣静脉修复:1例腓动脉穿支动脉伴行静脉-足(跖)背动脉伴行静脉端端吻合2条,5例腓动脉穿支动脉伴行静脉-足(跖)背动脉伴行静脉端端吻合1条;3例腓动脉穿支动脉伴行静脉-足(跖)背动脉伴行静脉端端吻合1条加腓动脉穿支动脉伴行静脉-足背浅静脉端端吻合1条.术后9例皮瓣全部成活,未发生血管危象,修复1条静脉与修复2条静脉皮瓣肿胀情况肉眼观察无明显差异;受区、供区创面均一期愈合;术后随访2～6个月,1例因皮瓣臃肿术后5个月行皮瓣整形,其他皮瓣皮肤质地、颜色满意. 结论小腿外侧腓动脉穿支皮瓣游离移植摆脱了带蒂皮瓣的束缚,使手术设计和实施相对自由,对皮瓣供区、受区的创伤均得到有效控制.该皮瓣的血管解剖相对稳定、血供可靠、切取简单、皮肤质地与足部接近修复效果好、供区受区可在同一麻醉同一个止血带下完成,是修复前足部创面一个很好的选择.
목적 분석소퇴외측비동맥천지피판적특점,탐토비동맥천지피판유리이식수복전족창면적림상응용. 방법 회고성분석소퇴외측비동맥천지피판유리이식수복전족창면환자9례,피부결손면적위4.5 cm×4.0cm～13.5 cm×6.5 cm;착중분석전족창면적특점이급소퇴외측비동맥천지피판적설계、절취、혈관문합필배등,술후수방피판적성활、외관급과족적공능회복정황등. 결과 9례균재소퇴외측이비골소두여외과련선중점초상방부근조도발자비동맥적교대기피천지,차유명현적2조정맥반행.이식피판정맥수복:1례비동맥천지동맥반행정맥-족(척)배동맥반행정맥단단문합2조,5례비동맥천지동맥반행정맥-족(척)배동맥반행정맥단단문합1조;3례비동맥천지동맥반행정맥-족(척)배동맥반행정맥단단문합1조가비동맥천지동맥반행정맥-족배천정맥단단문합1조.술후9례피판전부성활,미발생혈관위상,수복1조정맥여수복2조정맥피판종창정황육안관찰무명현차이;수구、공구창면균일기유합;술후수방2～6개월,1례인피판옹종술후5개월행피판정형,기타피판피부질지、안색만의. 결론 소퇴외측비동맥천지피판유리이식파탈료대체피판적속박,사수술설계화실시상대자유,대피판공구、수구적창상균득도유효공제.해피판적혈관해부상대은정、혈공가고、절취간단、피부질지여족부접근수복효과호、공구수구가재동일마취동일개지혈대하완성,시수복전족부창면일개흔호적선택.
Objective To analyze features of the lateral leg peroneal artery perforator free flap,and study the clinical application of free peroneal artery perforator flap transplantation for repairing forefoot defects.Methods Retrospectively analyzed 9 patients with forefoot defects which had been repaired with free lateral leg peroneal artery perforator flap transplantation.In this group,the skin and soft tissue defects size were 4.5 cm ×4.0 cm-13.5 cm × 6.5 cm,Focused on analyzing the features of forefoot skin and soft tissue defects,the design and harvesting of lateral leg peroneal artery perforator flap,and vascular anastomosis and vessel matching,meanwhile,follow-up the survival condition and appearance of the flap,the function of foot and ankle after operation.Results In the 9 cases,the larger myocutaneous perforator arising from peroneal artery,accompanying 2 vena comitans,were found slightly above the midpoint of the line between fibula head and lateral malleolus in lateral leg.The flaps transfered to repair forefoot defects,artery end-end anastomosis:in 5 cases cutaneous branch of peroneal artery to dorsal artery of foot,in 4 cases by cutaneous branch of peroneal artery to dorsal metatarsal artery;vein end-end anastomosis:in 1 case 2 accompanying veins of peroneal artery cutaneous branch to 2 accompanying veins of dorsal artery of foot,in 5 cases 1 accompanying vein of peroneal artery cutaneous branch to 1 accompanying vein of dorsal artery of foot or metatarsal,in 3 cases 1 accompanying vein of peroneal artery cutaneous branch to 1 accompanying vein of dorsal artery of foot or metatarsal,simultaneously,the another accompanying vein of peroneal artery cutaneous branch to 1 dorsal superficial vein of the foot.All the 9 flaps survived,and no vessel articulo happened.The venous return of flaps had no significant difference between repairing 1 vein and 2 veins in gross appearance.All wounds healed in one-period.Followed-up 2-6 months postoperative,1 patient was performed flap reshaping due to flap fat and clumsy at 5 months postoperative,others,the skin texture and appearance of the flaps were good and satisfactive.Conclusion Free transplantation of the lateral leg peroneal artery perforator flap broke away from the bondage of pedicled flap,had more freedom in flap design,and effectively controlled the trauma of donor and recipient site.The flap have the merits,blood vessel anatomy is relatively stable,blood supply is reliable,harvesting is simple,skin texture is similar to the forefoot and the effect is better,operation of the donor and recipient sites can accomplish under a identical anaesthesia and tourniquet.Thus,the lateral leg peroneal artery perforator free flap is an effective metheod in reparation of the forefoot defects.